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System-based strategy for the management of meconium aspiration syndrome: 198 consecutive cases observations.
Acta Paediatr Taiwan. 2005 Mar-Apr; 46(2):67-71.AP

Abstract

To evaluate whether the system-based strategy for management of meconium aspiration syndrome (MAS) could reduce the morbidity and mortality rate of MAS in our institute, a prospective consecutive clinical observation was conducted. System-based strategy including appropriately trained the relevant medical staff to familiar with neonatal resuscitation program, early surfactant replacement or lavage following with high-frequency ventilator (HFV) and/or inhaled nitric oxide (iNO). Outcome measurements were the morbidity and mortality rates of MAS. All infants of MAS in the study period were included except cases of congenital malformations or cyanotic congenital heart disease (CHD). Oxygen, nasal continuous positive airway pressure (CPAP), and intermittent mandatory ventilation (IMV) were applied as clinically indicated. Surfactant was used as replacement or lavage therapy for MAS infants whose oxygen index (OI) exceeded 20 or value for AaDO2 exceeded 400 within 6 hours of age. High-frequency oscillator ventilation (HFO) was applied for infants of MAS that demonstrated intractable respiratory failure with conventional mechanical ventilation and 100% oxygen. Inhaled nitric oxide (iNO) was used with IMV or HFO for infants of persistent pulmonary hypertension (PPHN) when it was unresponsive to conventional therapy. Dexamethasone was prescribed in infants of severe hypotension that did not respond to dopamine and epinephrine. A series of 198 consecutive infants of MAS born in this hospital during 9 years were analyzed. There was no mortality. Fourteen infants developed PPHN, 11 had pneumothorax, 1 had pulmonary hemorrhage, 2 had neurologic sequelae because of severe asphyxia, and 2 developed bronchopulmonary dysplasia. Our results indicated that appropriately trained relevant medical staff with neonatal resuscitation program to avoid complicated MAS and early surfactant replacement or lavage following with HFO and/or iNO could reduce the morbidity and mortality rate of MAS even without extracorporeal membrane oxygenation (ECMO).

Authors+Show Affiliations

Lin HC
Department of Pediatrics, China Medical University Hospital, China Medical University, Taichung, Taiwan. d0373@www.cmuh.org.tw
Su BH
No affiliation info available
Lin TW
No affiliation info available
Tsai CH
No affiliation info available
Yeh TF
No affiliation info available

MeSH

Administration, InhalationAsphyxia NeonatorumHigh-Frequency VentilationHumansHypertension, PulmonaryInfant, NewbornMeconium Aspiration SyndromeMorbidityNitric OxidePneumothoraxProspective StudiesSurvival RateTaiwanTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16302581

Citation

Lin, Hung-Chih, et al. "System-based Strategy for the Management of Meconium Aspiration Syndrome: 198 Consecutive Cases Observations." Acta Paediatrica Taiwanica = Taiwan Er Ke Yi Xue Hui Za Zhi, vol. 46, no. 2, 2005, pp. 67-71.
Lin HC, Su BH, Lin TW, et al. System-based strategy for the management of meconium aspiration syndrome: 198 consecutive cases observations. Acta Paediatr Taiwan. 2005;46(2):67-71.
Lin, H. C., Su, B. H., Lin, T. W., Tsai, C. H., & Yeh, T. F. (2005). System-based strategy for the management of meconium aspiration syndrome: 198 consecutive cases observations. Acta Paediatrica Taiwanica = Taiwan Er Ke Yi Xue Hui Za Zhi, 46(2), 67-71.
Lin HC, et al. System-based Strategy for the Management of Meconium Aspiration Syndrome: 198 Consecutive Cases Observations. Acta Paediatr Taiwan. 2005 Mar-Apr;46(2):67-71. PubMed PMID: 16302581.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - System-based strategy for the management of meconium aspiration syndrome: 198 consecutive cases observations. AU - Lin,Hung-Chih, AU - Su,Bai-Horng, AU - Lin,Tsung-Wen, AU - Tsai,Chang-Hai, AU - Yeh,Tsu-Fuh, PY - 2005/11/24/pubmed PY - 2006/1/27/medline PY - 2005/11/24/entrez SP - 67 EP - 71 JF - Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi JO - Acta Paediatr Taiwan VL - 46 IS - 2 N2 - To evaluate whether the system-based strategy for management of meconium aspiration syndrome (MAS) could reduce the morbidity and mortality rate of MAS in our institute, a prospective consecutive clinical observation was conducted. System-based strategy including appropriately trained the relevant medical staff to familiar with neonatal resuscitation program, early surfactant replacement or lavage following with high-frequency ventilator (HFV) and/or inhaled nitric oxide (iNO). Outcome measurements were the morbidity and mortality rates of MAS. All infants of MAS in the study period were included except cases of congenital malformations or cyanotic congenital heart disease (CHD). Oxygen, nasal continuous positive airway pressure (CPAP), and intermittent mandatory ventilation (IMV) were applied as clinically indicated. Surfactant was used as replacement or lavage therapy for MAS infants whose oxygen index (OI) exceeded 20 or value for AaDO2 exceeded 400 within 6 hours of age. High-frequency oscillator ventilation (HFO) was applied for infants of MAS that demonstrated intractable respiratory failure with conventional mechanical ventilation and 100% oxygen. Inhaled nitric oxide (iNO) was used with IMV or HFO for infants of persistent pulmonary hypertension (PPHN) when it was unresponsive to conventional therapy. Dexamethasone was prescribed in infants of severe hypotension that did not respond to dopamine and epinephrine. A series of 198 consecutive infants of MAS born in this hospital during 9 years were analyzed. There was no mortality. Fourteen infants developed PPHN, 11 had pneumothorax, 1 had pulmonary hemorrhage, 2 had neurologic sequelae because of severe asphyxia, and 2 developed bronchopulmonary dysplasia. Our results indicated that appropriately trained relevant medical staff with neonatal resuscitation program to avoid complicated MAS and early surfactant replacement or lavage following with HFO and/or iNO could reduce the morbidity and mortality rate of MAS even without extracorporeal membrane oxygenation (ECMO). SN - 1608-8115 UR - https://www.unboundmedicine.com/medline/citation/16302581/System_based_strategy_for_the_management_of_meconium_aspiration_syndrome:_198_consecutive_cases_observations_ DB - PRIME DP - Unbound Medicine ER -